Vaccines

Influenza comes in what two type of vaccine(s)? What are the routes?

Live-attenutated (LAIV) → IN

Inactivated (IIV) → (IM/ID)

For the LAIV, what are the contraindications?

• < 2 yrs or > 50 yrs

• Immunocompromised

• 2-17 yrs with asthma or taking aspirin

Why is aspirin contraindicated in children/teenagers for certain viral vaccines (ie. influenza) or conditions?

Can lead to Reyes Syndrome (liver and brain swelling and damage)

What is the recommended vaccination age & timeline for influenza?

≥ 6 months, once annually

For the inactivated influenza vaccine (IIV), what are the contraindications?

• < 6 months old

• Egg allergy

• Allergies to Flu vaccine or any of its components

• Has or previously had Guillain-Barré Syndrome (immune system attacks nerves)

Why is asthma contraindicated in children/teenagers when taking the LAIV?

The live virus in the nasal spray can trigger respiratory distress, wheezing, and other issues

What are the two types of influenza vaccines? How many flu strains does each defend against, and which ones?

Trivalent: 3 strains → 2 A and 1 B strain

Quadrivalent: 2 strains → 2 A and 2 B strains

Manifestations of Influenza

• Wheezing 

• Body aches

• Myalgias (muscle pain)

• Headache

• Malaise 

• Inflammation → possible pneumonia (SOB, cough, clear/white sputum, ↓O₂ sat)

• Low-grade fever

• Chills

• Nasal Congestion

• Cough

Manifestations of Pneumococcal disease?

• Productive Cough

• Colorful sputum (ie., blue, green, yellow, tan)

• Difficulty breathing

• Increased respiratory rate

• Decreased O₂ sat

• Noise in lungs

• Other: ear infection, sinus infection, pneumonia, sepsis, meningitis, death

What are the two pneumococcal vaccines? Through what routes are each administered? What do each contain?

Pneumococcal polysaccharide vaccine (PPSV23)

• IM or SC

• 23 types of bacteria that cause pneumococcal disease

(PPSV23) Pneumococcal conjugate vaccine (PCV13)

• IM

• 13 types of bacteria that cause pneumococcal disease

Who is recommended for the PPSV23?

• Adults ≥ 65 yrs

• Immunocompromised, ≥ 2 yrs

Who is recommended for the PCV13?

1. < 5 years → 4 series of doses

   1. 2 months

   2. 4 months

   3. 6 months

   4. Between 12-15 months

2. ≥ 65 yrs

3. ≥ 6 years with certain chronic illnesses

The Hepatitis B vaccine is what type of vaccine? Through what route is it administered?

• Recombinant subunit

• IM

Who is recommended for the Hepatitis B vaccine?

• All patients beginning at birth

• At-risk infants

• Those who share IV needles/injectable equipment

• Men who have sex with men

• Those with HBV-positive sexual partners

• Those not in a monogamous relationship

How is HBV transmitted? Who is at risk?

• Transmission: Blood (ie. transfusions, needles), bodily fluids (via sexual contact), and perinatal (mother → baby during birth)

• At risk: IV drug abusers, HCPs, people with multiple sex partners, infants of infected mothers, men who have sex with men

Manifestations of Hepatitis B

• Fever

• Headache

• Malaise

• Anorexia

• Arthralgia

• Arthritis

• Jaundice

• Chronic infection → liver cirrhosis, liver cancer, and death

When would infants receive hepatitis B immunoglobulin (HBIG)?

If they’re at-risk for Hep B (mother is HBV+) → within 12 hours

Given along with Hep B vaccine

At-risk infants for HBV receive

HBIG and monovalent Hepatitis B vaccine within 12 hours after birth

Infants not at risk for HBV receive

monovalent Hepatitis B vaccine within 24 hours after birth

What type of vaccine is the tetanus vaccine? What are common names for it? through which route is it administered?

• Type: Toxoid

• Name: DTaP and Tdap (booster)

• Route: IM

How can someone get infected with tetanus?

Environment: contaminated soil, rusty nail, manure

Clostridium tetani enters wound and produces toxins (ie. tetanospasmin) that interfere with nerve signaling

Manifestations of Tetanus

• Muscle stiffness and rigidity in jaw, neck, and abdomen

  • Larynx spasticity: strained/tightened voice, voice breaks

• Muscle spasms and tremors

• Difficulty swallowing, speaking, and breathing

• Fever

• Broken bones

What are the age/dose recommendations for tetanus vaccine?

• All children: 5-dose series

  • 2 months

  • 4 months

  • 6 months

  • 15-18 months

  • 4-6 yrs

• Booster every 10 yrs

• All HCPs

TDaP and Tdap are for what age ranges? What is the difference between the two?

TDaP (active immunization): 6 wks to 6 yrs

Tdap (active booster): ≥10 yrs

Both contain the same Ags, but different amounts (concentration)

What are the recommendations for the tetanus vaccine if a person gets injured and has a contaminated, dirty wound?

If the patient received the tetanus vaccine

<5 yrs ago → assumed immunity

>5 yrs ago → booster (Tdap)

>10 yrs ago (regardless of injury) → booster (Tdap)

What type of vaccine is the Varicella (chickenpox) vaccine? Through what route is it administered?

• Type: live-attenuated

• Route: SC

Manifestations of Varicella (Chickenpox)

More severe in older children and adults, highly contagious and airborne:

• Scarring

• Blister-like rash

• Redness

• Pain

• Fever

• Respiratory Issues (later in life)

• Complications: encephalitis, bacterial skin infections, pneumonia, Reye syndrome, and death

What are the age/dose recommendations for the varicella vaccine?

• All children: 2-dose series

  • 12-15 months

  • 4-6 yrs

What are the contraindications for the varicella vaccine?

• Immunocompromised

• Pregnancy or possibility of pregnancy within 1 month

• Previous anaphylaxis to vaccine or any of its components

• Aspirin or other salicylates

• Other: active, untreated TB infection, moderate-to-severe acute illness

What are some common side effects and possible adverse effects of the varicella vaccine?

Side Effects

• Localized/confined redness and soreness around injection site

• Fever

Adverse Effects

• Anaphylaxis

• Encephalitis

  • Brain inflammation

• Thorombocytopenia

  • Low platelet count→ bruising/bleeding risks

• Stevens-Johnson Syndrome (SJS)

  • Flu-like symptoms, painful blister-like rashes, and outer skin layer detachment

• Reyes Syndrome (possible with aspirin)

Varicella requires what type of precautions?

• Standard (gloves)

• Contact (gown + gloves)

• Airborne (N95 mask + negative pressure room)

What are the two types of Herpes zoster vaccines? Through which routes are they administered? What are the names? Which one was discontinued? How many doses does each require?

• Live-attenuated: Zostavax (SC) → discontinued

  • 1 doses

• Recombinant subunit: Shingrix (IM)

  • 2-dose series

Manifestation of Herpes Zoster (Shingles)

• Unilateral, local red, painful blister-like rash  

• Chronic severe pain post blister (postherpetic neuralgia)

What is the recommended age and dosing for the current Herpes zoster vaccine (Shingrix)?

• Recombinant subunit (Shingrix), IM

  • ≥ 50 years

    • 2nd dose: 2-6 months after 1st dose

  • ≥ 19 yrs who are or will be immunocompromised or immunosuppressed

    • 2nd dose: 1-2 months after 1st dose

Herpes Zosta, commonly known as 1)_________ is the reactivation of the 2)_______________, which lays dormant in the body after causing 3)__________.

When reactivated, it travels along a 4)______ that doesn’t cross the body’s ________, leading to ________ manifestations on the skin. The 5)______ in the ________ is highly contagious. The patient is no longer contagious when it is drained out, and the wound 6) ______ over.

1. Shingles

2. Varicella-zoster virus (VZV)

3. Varicella (Chickenpox)

4. nerve; midline; unilateral

5. fluid; blisters

6. scabs

What are contraindications for the herpes zoster vaccine?

• Previous anaphylaxis or current allergies to herpes zoster vaccine or any of its components

• Pregancy

• Moderate-to-severe acute illness

What are some brand names for the COVID-19 vaccine? What type of vaccine is it? Through what route is it administered?

Names: Pfizer, Moderna, Novavax

Type: Nucleic Acid (mRNA)

Route: IM

Manifestations of COVID-19

• Fever

• Muscle aches

• Headache

• Cold symptoms

• Nausea/vomiting/diarrhea

• Loss of taste and smell

• Conjunctivitis (red eyes)

What are the age and dosing recommendations for the COVID-19 vaccine brands?

• Moderna (2-dose series)

  • Dose: 28 days apart

  • Age: ≥ 6 months

• Pfizer (2-dose series)

  • Dose: 21 days apart

  • Age: ≥ 6 months

• Novavax (3-dose series)

  • Dose: 21 days, 6 months

  • Age: ≥ 12 yrs

What are the contraindications for the COVID-19 vaccine?

Previous anaphylaxis or current allergies to COVID-19 vaccine or any of its components